The Battery Dilemma on IT or Medical Carts.

When moving to a new digital workflow the costs of carts, software and connected devices are all key factors for those responsible for the final purchase decisions.
All too often battery power is considered to be no more than another necessary expense. Yet, software aside, it is the most frequently documented point of failure on powered Hospital carts.
A short-sighted view of requirements coupled with budget constraints mean a cheaper battery with a 1-year warranty is good enough for many.  Such warranties may only cover functionality – or capacity to a low 60% level – at which a Li-Ion battery is substandard in terms of reliability and safety, the plan-runtime is nearly halved in less than 15% of the carts predicted life!

There are multiple benefits of carts and digitization: cost efficiency in nurse time, test logistics and medication costs; improved data accuracy and thus patient outcomes; realtime information for doctors and management; legal clarity; improved cost overview; higher patient satisfaction, and better data for AI. All of which promise enormous gains, but all depend on documentation at the point of care.

A substandard battery system undermines this, by conditioning nurses to plug the cart in to charge the battery whenever possible. Cart location then changes; efficiency is lost, double documentation returns. This is the picture across many Hospitals worldwide.

Initially, laptops with their built-in battery and ease of use proved the preferred option with medical cart adoption. Fast Forward 2 to 3 years and battery runtime is massively reduced with most no longer able to complete a shift without the need to plug in and recharge.

In normal circumstances a laptop battery is exposed to very few “full cycles” in its life. In the hospital scenario, these full cycles can and do occur daily, meaning a faster decline in the life cycle of the battery and ultimately the laptop itself.

In an effort to address these issues the market turned firstly to lead-acid blocks, then NiMH and then Lithium-Ion, all without ever addressing the root cause of substandard batteries.

A common scenario for medical carts is to use a 300-600Wh Lithium Phosphate Block batteries with an inverter.

The inverter will take c 20W per hour, so 240Wh per 12-hour day.

Typically, IT applications need 50W an hour, so 600w per 12-hour day.

Totalling 840Wh per 12-hour day.

A 500Wh block battery with a 1-year warranty which can drop to  60% resulting in a 300Wh battery by the end of year 1-  while the cart still has 6 years of full and active service remaining.

It is clear to see that these figures do not add up, with the result being the need for this cart to spend most of its working day plugged into the mains, removing the key competency of a medical cart; mobility.

The only power concept that can theoretically avoid the needs for mains power over a 12 hour period, let alone 24/7 is the adoption of a hot-swap system that will support the cart throughout its 7 year life cycle

However, the trend is back to substandard laptop type batteries in All-In-One monitors! Back to the beginning, with the hope that such medical batteries can now magically survive the Hospital high cycle scenario.

Why? Because they are cheap to sell/buy with the single-year budget. If no-one cares about failure in year 2,3,4,5,6, & 7 that would be rational! Why is a failure on this scale not acceptable for any part of the cart except the power system? It’s not! The real issue is misleading sales practices coupled with a lack of awareness across multiple departments, where many decision-makers genuinely have no concept of the impact and domino effect of unreliable and short-lived batteries.

The dilemma for the hospital is to accept the frailties of substandard batteries or adopt a hotswap system designed to run the cart for its complete life cycle.

 The initial price will be higher. But analysing the TCO over the life time of the cart and factoring for continually replacing the battery will paint a truer picture of the total cost of ownership in purely fiscal terms.

Factor in all the costs of failure (nurse, admin, maintenance, logistics, disposal – time and costs), and the quality system delivers a significant saving.
But that is just a power system cost. The real Return on the Hospitals massive investment must consider the impact on the overall digitalisation project. The cost benefit here is enormous.

1) See “All Charged Up- The many challenges of battery maintenance” Martha Vockey, 2014 in Biomedical Instrumentation & Technology. Quotes FDA study: 50% of Hospital service calls are battery related.

 Staff costs often account for over half a Hospital budget. There is a shortage of qualified nurses and that is predicted to grow. Nurse time spent on IT is close to 50%. Doctor & Nurse time productivity should be a massive topic. If a Nurse wastes 5 minutes an hour, walking to and from a plugged-in cart, logging in and out, the extra costs over 7 years of a cart life are over £100,000. This is just a proportion of the potential savings lost. So, to save £1000 or £2000 on a battery system, Hospitals take a massive productivity hit and ensure that the very noble aims of going digital are undermined from the outset by opting for a substandard battery system.

Calculations  – adjust to your rates.

Nurse cost per Hour: £40. 5 minutes lost per hour: 0,083 x 40 = £3.33 / hour 

Cart life in hours:
12 Hour day: 12 x 365 x 7 = 30660 hours   (30660 x 3.33 = £102,097.80)
4 Hour day: 24 x 365 x 7 = 61320 hours    (61320 x 3,33 – £204,195.60)

Some points to consider.

Back pain and strain issues – not helped by pushing heavy carts and bending/stretching to plug in and out – represents a major productivity loss with a high percentage of nurses taking time off from work as a result. Clinical staff may walk 8km a shift and spend hours fetching supplies.

Dissatisfaction with time wasted around documentation away from the patient at the point of care is a key reason given for workplace dissatisfaction and the high dropout rates of qualified nurses.

An average European Hospital makes 800 mistakes per day. Patient identification, medication errors, incorrect tests, etc. Real-time Point of Care documentation – avoiding delayed double documentation is the best method of countering this. Studies have shown that Death rates fall by c 15% when P.o.C documentation is achieved, so there is a massive Patient outcome benefit.

 

Conclusion

Only a fully mobile cart – no plugging in – no downtime for charging – available around the clock at the Point of Care can effectively addresses these issues, empowering clinical staff to provide uninterrupted care with more face to face patient interaction. This is a Hot Swap solution!

The relevant pre-selection criteria for the Hospital should be about the impact of the battery system on Productivity, Workflow and Patient outcomes over the whole cart life. The Kinetic Power Hot-swap system is the best in class for this.

This is all about value delivered and Whole Life Costs and should not just be – as is so frequently the case -about the lowest price available. That mindset forces Cart resellers to offer the lowest cost (poorest performing) cell packs; and the Hospital then endures substandard battery performance, increasing reliability issues, high replacement costs and worst of all will not achieve clinical KPIs central to the Digitalisation project.

[2] See Harvard Business review, Jan 10, 2019. TECHNOLOGY 3 Ways to Make Electronic Health Records Less Time Consuming for Physicians by Derek A. Haas, John D. Halamka and Michael Suk. “The annual cost of physicians spending half of their time using EHRs is over $365 billion”

[3] Nurses and Back Pain: June 18th, 2012, by Jennifer Olin, BSN, RN. Back injuries to nurses have ….a lifetime prevalence of 35-80 percent!

[4] Martin Poppelaars, 2012: www.telecomengine.com/article/critical-condition-medical-device-connectivity

[5] Archives of Internal medicine, January 2009; “Computers reduce odds of in-hospital deaths”. Research by John Hopkins school of Medicine. Similar result in UK study – see MailOnline Oct 4th 2016: “Nurses’ poor handwriting and maths is costing lives“: Death rate at two hospitals falls 15% when staff were given electronic devices to record information.

[6] Please contact KineticID at info@dkinetic-id.com  for details on any facts and figures in this text.

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